Provider Demographics
NPI:1861603417
Name:O'BRIEN, MICHAEL (AAS, CAC-II, SST)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:AAS, CAC-II, SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 16 1/2 MILE RD
Mailing Address - Street 2:APT 102
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-1844
Mailing Address - Country:US
Mailing Address - Phone:586-795-9465
Mailing Address - Fax:248-454-6557
Practice Address - Street 1:36 W TENNYSON AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-2668
Practice Address - Country:US
Practice Address - Phone:248-454-0407
Practice Address - Fax:248-454-6557
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)